A randomized trial comparing methods of vaginal cuff closure at vaginal hysterectomy and the effect on vaginal length

The objective of the study was to compare the effect of horizontal versus vertical closure of the vaginal cuff during vaginal hysterectomy on vaginal length. Forty-three women were randomized to undergo horizontal (n = 23) or vertical (n = 20) vaginal cuff closure during vaginal hysterectomy at a community hospital. The primary outcome of vaginal length before and after surgery was compared by the Student t test and the paired t test. Preoperatively mean vaginal lengths in the horizontal and vertical groups were statistically similar (7.76 ± 1.23 cm versus 8.28 ± 1.39 cm, respectively; P = .21). Postoperatively the groups statistically differed (6.63 ± 1.02 cm versus 7.93 ± 1.18 cm, P < .001). The mean change in vaginal length was –1.13 ± 1.15 cm and –0.35 ± 0.91 cm, respectively ( P = .01). Within-group comparisons revealed a statistical difference between pre- versus postmean vaginal length in the horizontal group (7.76 ± 1.23 cm versus 6.63 ± 1.02 cm; P < .001) and no difference within the vertical group (8.28 ± 1.39 cm versus 7.93 ± 1.18 cm; P = .11). Closing the vaginal cuff vertically is superior to horizontal closure for the purpose of preserving vaginal length.